Provider Demographics
NPI:1407853120
Name:FRANK, TERRENCE R (DO)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:R
Last Name:FRANK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 S PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3496
Mailing Address - Country:US
Mailing Address - Phone:517-487-3655
Mailing Address - Fax:517-487-3664
Practice Address - Street 1:2815 S PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3496
Practice Address - Country:US
Practice Address - Phone:517-487-3655
Practice Address - Fax:517-487-3664
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2013-11-05
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MITF005949208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5332451OtherMICHIGAN BLUE SHIELD
MI1075490Medicaid
MI1075490Medicaid
MI0C36084059Medicare PIN